Response to Abtahi et al.'s Letter

To the Editor:

We appreciate the interest and comments of Abtahi and associates and their concerns about our article. As pointed by the authors, ciliochoroidal effusion syndrome may be defined as a spectrum of clinical presentations ranging from transient myopia to severe bilateral acute angle closure glaucoma (AACG). In both case reports,^1,2 only transient myopic shift occurred with low dosage and duration of topiramate. However, our case can be considered as the first case of AACG resulting from severe ciliochoroidal effusion syndrome with such minimal dosage and duration of topiramate (only 25 mg of topiramate once a day for 2 days).

We do agree with the authors that our article provides further evidence for the idiosyncratic nature of ciliochoroidal effusion syndrome induced by topiramate. We also believe that there is no correlation between topiramate dosage and the level of findings in AACG patients.

Our case was intravenously treated with mannitol 20% (5 mL/kg), oral acetazolamide tablets 250 mg 3 times a day (for 2 days), timolol maleat/dorzolamide hydrochloride ophthalmic solution, and brimonidine tartarate eye drops topically twice a day in both eyes. From the second day, the intraocular pressure (IOP) were dropped in both eyes; thus, acetazolomide tablets were stopped. The use of acetazolamide in treatment of such a case is still controversial, yet we did not observe any side effects.